08 August 2012
An immediate denture is a complete or removable partial denture that is constructed prior to the extraction of teeth which it will replace and is inserted immediately following the removal of natural teeth.
Classification of immediate denture
- Conventional immediate denture
- Delayed immediate denture
- Transitional immediate denture
IMAGES
A) Conventional
Flanged and socketed
1. Socketed
-Removable partial denture
-Complete denture
2. Flanged
1. Without alveolectomy
-partial flange
-complete flange
2.With alveolectomy
-septal
-Radical
ADVANTAGES
- Maintenance of appearance
- Tooth selection and arrangement can be easily duplicated
- Maintaince of the masticatory movement patterns of the mandible
- Maintaince of vertical and maxilla-mandibular relationsip so changes in the facial muscle tone and supporting structure are reduced.
- Superior neuromusculature control.
- Minimum interference with speech.
- Fast adaptation to immediate denture
- Prevention of tongue enlargement
- Possible control on alveolar ridge resorption
- Healing period with teeth
- Improve appearance
- Spilnt to control bleeding
- Prevent patient embarrassment after extraction
DISADVANTAGES
- If poor oral health then it may be infection or edema following extraction of teeth.
- Additional treatment time
- The additional expence of relining immediate dentures three to six months after insertion.
- Less retention is expected.
CONTRAINDICATION
- Patient with acute infections such as periapical abscesses or periodontal abscesses.
- Patient under radiation therapy
- Extensive bone loss
- Patient with severe gag reflex
08 August 2012 0
A malocclusion is a misalignment of teeth and incorrect relation between the teeth of the two dental arches. The term defined by Edward angel, the “Father of modern orthodontics.
Etiology of malocclusion
Graber’s classification
General factors
1. Heredity
2. Congenital
3. Environment
a) Prenatal (trauma, maternal diet, German measles, maternal metabolism etc.)
b) Post natal ( birth injury, cerebral palsy, T.M.J. injury )
4. Pre-disposing metabolic climate and disease
a) Endocrine imbalance
b) Metabolic disturbance
c) Infectious disease
5. Dietary problems ( nutritional deficiency )
6. Abnormal pressure habits and functional aberrations
a) Abnormal sucking
b) Thumb and finger sucking
c) Tongue thrust and tongue sucking
d) Lip and nail biting
e) Abnormal swallowing habits
(Improper deglutition)
f) Speech defects
g) Respiratory abnormalities
(Mouth breathing etc,)
h) Tonsils and adenoids
i) Psychogenic tics and bruxim
j) Posture
k) Trauma and accidents
Local Factors
- Anomalies of number : Supernumerary teeth, Missing teeth (congenital absence or loss due to accidents, caries, etc)
- Anomalies of tooth size
- Anomalies of tooth shape
- Abnormal labial frenum : mucosal barriers
- Premature loss
- Prolonged retention
- Delayed eruption of permanent teeth
- Abnormal eruptive path
- Ankylosis
- Dental caries
- Improper dental restorations
WHITE AND GARDINER’S CLASSIFICATION
A. Dental base abnormalities
- Antero-posterior malrelationship
- Vertical malrelationship
- Lateral malrelantionship
- Disproportion of size between teeth and basal bone
- Congenital abnormalities
B. Pre-eruption abnormalities
- Abnormalities in position of developing tooth germ
- Missing teeth
- Supernumerary teeth and teeth abnormal in form
- Prolonged retention of deciduous teeth
- Large labial frenum
- Traumatic injury
C. Post-eruption abnormalities
- Muscular
- Active muscle force
- Rest position of musculature
- Sucking habits
- Abnormalities in path of closure
- Premature loss of deciduous teeth
- Extraction of permanent teeth
Malocclusion can be broadly divided into
- Individual teeth malposition or intra arch malocclusion
- Malrelation of dental arches to one another upon bony bases which may themselves be normally related.
- Skeletal malocclusion which involve the underlying bony bases.
INDIVIDUAL TEETH MALPOSITION
A tooth can be abnormally related to its neighboring teeth such abnormally related to its neighboring variations are called individual teeth malposition or intra arch malocclusion. Some commonly seen individual teeth malpositions are
- Distal inclination or distal tipping
- Mesial inclination or mesial tipping
- Lingual inclination or lingual tipping. This condition is also called retroclination
- Buccal inclination or Buccal tipping. This refers to labial or buccal tilting of tooth. This condition is also called proclination.
- Mesial displacement
- Distal displacement
- Lingual displacement
- Buccal displacement
- Infraversion or infraocclusion
- Supraversion or supraocclusion
- Rotations
- Disto-lingual or mesio-buccal rotation
- Mesio-lingual or disto-buccal rotation
- Transposition
MALRELATION OF DENTAL ARCHES
These malocclusions are characterized by abnormal relationship between two teeth or groups of teeth of one arch to the other arch.
These interarch malooclusion can occur in the saggital vertical or in transverse planes of space.
IMAGES
ANGEL’S SYSTEM OF CLASSIFICATION
Edward Angel introduced a system of classifying malocclusion in the year 1899.
Basis for Angel’s classification
The Angel’s classification is based on the following criteria :
a) Angel’s classification was based on the mesio-distal relation of the teeth, dental arches and the jaws.
b) According to Angel, the maxillary first permanent molar is key to occlusion. He considered these teeth as fixed anatomical points within jaws.
c) Based on the relation of the lower first permanent molar to the upper permanent molar, he classified malocclusions into three main classes designated by the Roman numerals one, two, and three.
Based on the above mentioned principles, Angel classified malocclusion into the following broad categories.
Class I
Class II
Division 1
Division 2
Class III
These malocclusions are characterized by abnormal relationship between two teeth or groups of teeth of one arch to the other arch.
These interarch malooclusion can occur in the saggital vertical or in transverse planes of space.
A) Saggital plane malocclusion
Pre normal occlusion
This term refers to a condition where the lower arch is more forwardally placed when the patient bites in centric occlusion.
Post normal occlusion
This is a condition where the lower arch is more distally placed when the patient bites in centric occlusion.
B) Vertical plane malocclusions
Deep Bite or increased over bite
This refers to a condition where there is an excessive vertical overlap between upper and lower anterior teeth.
Open bite
This is condition where there is no vertical overlap between the upper and lower teeth.
Thus space exist between the upper and lower teeth when patient bites in centric occlusion. The open bite can be in the anterior or posterior region .
C) Transverse plane malocclusions
The transverse plane interarch malocclusion includes various types of cross bites. The term cross bite refers to abnormal transverse relationship between the upper and lower arches.
Skeletal Malocclusions
They are malooclusions caused due to defects in the maxilla or mandible. The defects can be in size, position or relationship between the jaws.
IMAGES
ANGEL’S SYSTEM OF CLASSIFICATION
Edward Angel introduced a system of classifying malocclusion in the year 1899.
Basis for Angel’s classification
The Angel’s classification is based on the following criteria :
a) Angel’s classification was based on the mesio-distal relation of the teeth, dental arches and the jaws.
b) According to Angel, the maxillary first permanent molar is key to occlusion. He considered these teeth as fixed anatomical points within jaws.
c) Based on the relation of the lower first permanent molar to the upper permanent molar, he classified malocclusions into three main classes designated by the Roman numerals one, two, and three.
Based on the above mentioned principles, Angel classified malocclusion into the following broad categories.
Class I
Class II
Division 1
Division 2
Class III
Angle’s Class I classification of malocclusion
Angle’s Class I classification of malocclusion is characterized by the presence of a normal inter-arch molar relation. The mesio-buccal cusp of the maxillary first permanent molar occludes in the buccal groove of mandibular first permanent molar. The patient may exhibit dental irregularities such as crowding, spacing, rotations, missing tooth, etc.
These patients exhibit normal skeletal relation and also show normal muscle function. Another malocclusion that is most often categorized under Class I is bi-maxillary protrusion where the patient exhibits a normal Class I molar relationship but the dentition of both the upper and lower arches are forwardly placed in relation to the facial profile.
Angle’s Class II classification of malocclusion
This group is characterized by a Class II molar relation where the disto-buccal cusp of the upper first permanent molar occludes in the buccal groove of the lower first permanent molar. Angle has sub-classified
Class II malocclusion into two divisions:
Class II, Division 1 classification of malocclusion
The Class II, Division 1 classification of malocclusion is characterized by proclined upper incisors with a resultant increase in over jet. A deep incisor overbite can occur in the anterior region. A characteristic feature of this malocclusion is the presence of abnormal muscle activity. The upper lip is usually hypotonic, short and fails to form a lip seal.
The lower lip cushions the palatal aspect of the upper teeth, a feature typical of a Class II classification of malocclusion, Division 1 referred to as ‘lip trap’. The tongue occupies a lower posture thereby failing to counteract the buccinator activity. The unrestrained buccinator activity results in narrowing of the upper arch at the premolar and canine regions thereby producing a V-shaped upper arch.
Another muscle aberration is a hyper-active mentalis activity. The muscle imbalance is produced by a hyper-active buccinator and mentalis and an altered tongue position that accentuates the narrowing of the upper dental arch.
Class II, Division 2 classification of malocclusion
As in Class II, Division 1 classification of malocclusion, the Division 2 also exhibits a Class II molar relationship. The classic feature of this malocclusion is the presence of lingually inclined upper central incisors and labially tipped upper lateral incisors overlapping the central incisors. Variations of these forms are lingually inclined central incisor and lateral incisors with canine labiallytipped. The patients exhibit a deep anterior overbite.
The lingually inclined upper centrals give the arch a squarish appearance, unlike the narrow V-shaped arch seen in Division 1 classification of malocclusion. The mandibular labial gingival tissue is often traumatized by the excessively tipped upper central incisors. The patients exhibit normal perioral muscle activity. An abnormal backward path of closure may also be present due to the excessively tipped central incisors.
Class II, Subdivision classification of malocclusion
When a ClassII molar relation exists on one side and a Class I relation on the other, it is referred to as Class II, Subdivision. Based on whether it is a Division 1 or Division 2 it can be called Class II, Division 1, Subdivision or Class II, Division 2, Subdivision.
Class III malocclusion classification of malocclusion
This malocclusion exhibits a Class III molar relation with the mesio-buccal cusp of the maxillary first permanent molar occluding in the interdental space between the mandibular first and second molars. Class III classification of malocclusion can be classified into true Class III and pseudo Class III.
True Class III classification of malocclusion
This is a skeletal Class III classification of malocclusion of genetic origin that can occur due to the following causes:
a. Excessively large mandible.
b. Forwardly placed mandible
c. Smaller than normal maxilla.
d. Retro positioned maxilla.
e. Combination of the above causes
The lower incisors tend to be lingually inclined. The patient can present with a normal overjet, an edge to edge incisor relation or an anterior cross bite. The space available for the tongue is usually more. Thus the tongue occupies a lower position, resulting in a narrow upper arch.
Pseudo Class III classification of malocclusion
This type of malocclusion is produced by a forward movement of the mandible during jaw closure thus it is also called ‘postural’ or ‘habitual’ Class III classification of malocclusion. The following are some of the causes of pseudo Class III malocclusion:
a. Presenc
e of occlusal prematurity may deflect the mandible forward.
b. In case of premature loss of deciduous posteriors, the child tends to move the mandible forwardtoestablishcontactinanteriorregion.
c. A child with enlarged adenoids tends to move the mandible forward in an attempt to prevent the tongue from contacting the adenoids.
This is a condition characterized by a Class III molar relation on one side and a Class I relation on the other side.
Class III Subdivision classification of malocclusion
 |
 |
A. class I crowding | B. class II bimaxillary protrusion | c. spacing
d. spacing | e. classII division I | f. class II division II | g. Anterior cross bite
h. Anterior cross bite
|
 |
(I) Anterior cross bite | (J) Posterior cross bite | (k) Rotation | (L) Midline diastema |
(M) & (N) Anterior open bite | (O) & (P) Deep bite
|
Drawbacks of Angle’s classification
Angel’s classification has been used for almost a hundred years now; it still has a number of drawbacks that include:
- Angel considered malocclusion only in the antero-posterior plane. He did not consider malocclusions in the transverse and vertical planes.
- Angel considered the first permanent molars as fixed points in the skull. But this is not found to be so.
- The classification cannot be applied if the first permanent molars are extracted or missing.
- The classification cannot be applied to deciduous dentition.
- The classification does not differentiate between skeletal and dental malocclusion.
- The classification does not highlight the etiology of the malocclusion.
- Individual tooth malpositions have not been considered by Angle.
A fixed or removable orthodontic appliance for preserving the space created by the premature loss of one or more teeth. It can be unilateral or bilateral.
Space maintainers are appliance made of metal or plastic that is custom fit to your child’s mouth.
Primary teeth can be lost early for several reasons.
- Accident or knocked out in a fall
- Extraction because tooth cavity
- missing at birth
- some disease or condition can lead to every tooth loss.
Each one also acts as a guide for the permanent tooth that replaces it if deciduous tooth is lost early; the permanent tooth loses its guide. It can drift or erupt incorrectly into the mouth adjacent teeth can move into space. This means the permanent tooth can’t come in so space maintainers may be used.
Classification of space maintainers
According to Hitchcock (1973)
- Removable or fixed or semi fixed.
- With bands or without bands.
- Functional or Non functional
- Active or passive
- Certain combinations of the above
According Raymond C. Thurow (1978)
1.Removable
2.Complete arch
-Lingual arch
-Extra-oral anchorage
3.Individual tooth
According to Hinrichsen (1962)
1.Fixed space maintainers
Class 1
a) Non functional type
1) Bar type
2) Loop type
b) Functional types
1) Pontic type
2) Lingual arch type
Class 2 Cantilever type (distal shoe, band & loop)
2.Removable space maintainers
Acrylic partial dentures
IMAGES:
Mouth breathing refers to state of inhaling and exhaling through the mouth. Most normal people indulge in mouth breathing when they are under physical exertion such as during strenuous exercise or sports activity.
Mouth breathers can be classified into 3 types:
- Obstructive
- Habitual
- Anatomic
Obstructive: Complete or partial obstruction of the nasal passage can result in mouth breathing. The
following are some of the causes of nasal obstruction:
- Deviated nasal septum
- Nasal polyps
- Chronic inflammation of nasal mucosa
- Localized benign tumors
- Congenital enlargement of nasal turbinates
- Allergic reaction of the nasal mucosa
- Obstructive adenoids
Habitual: A habitual mouth breather is one who continues to breathe through his mouth even though the nasal obstruction is removed. Thus mouth breathing becomes a deep rooted habit that is performed unconsciously.
Anatomic: An anatomic mouth breather is one whose lip morphology does not permit complete closure of the mouth, such as a patient having short upper lip.
Causes of mouth breathing
- Excessive use of pacifier during infancy
- Recurring allergies
- Constriction of upper airways
- Malpositioned of lower jaw
- nasal polyps
- deviation of nasal septum
- tonsil hypertrophy
IMAGES:
Mouth Breathing Effect
1. Oral Health Degeneration: Excessive mouth breathing causes gum diseases and bad breath due to altered bacterial flora. Also, it can lead to hypo tonicity of the upper lip and hyperactivity of the lower lip. It may also stunt dental growth as well as growth of jaw bones, besides making the palate vault higher than usual. Mouth breathing is responsible for compromising the airway by increasing tonsil size and blocking the airway to such an extent that it becomes impossible to breathe through the nose. It also dries the mouth and imparts an adenoid face due to deformed jaws of the affected individual.
2. Weak Immune System: Breathing from the nose produces a tissue hormone which regulates normal blood circulation. It also helps filter, warm and humidify the air. The lack of oxygen in mouth breathers, who are also chronic snorers and struggle for air, weakens the immune system, disrupts sleep cycles, and obstructs the production of growth hormone.
3. Faulty Posture of Head, Neck and Shoulders: Breathing through the mouth instead of the nostrils produces a reflex forward head posture which put undue load on the neck and upper shoulders. Should this load be sustained for a long time, the posture of this area can get altered permanently. This in turn can affect the hips knees and feet.
4. Obstructive Sleep Apnea (OSA): Many researchers have attributed OSA to Sudden Infant Death Syndrome (SIDS), which is symptomized by snoring and ADHD. It can occur in adults and snoring is an essential sign of it.
Mouth Breathing in Children
In children, this type of abnormal breathing might manifest as drooling, sleeping open-mouthed, disturbed sleep, snoring, nasal irritation and obstruction, irritability during the day, etc. The causes of mouth breathing in children can be attributed to the presence of a similar abnormal breathing practice in parents, overfeeding, over clothing, inclusion of junk food and exclusion of nutritional food from the infant's diet, sedentary lifestyle, etc. The effects of mouth breathing in children span a large variety of medical conditions. Prominent among these are allergic rhinitis, malocclusion, enlarged tonsils, higher gingival index levels, facial and postural deformation, bad breath, obstructive nasal septum deviation, etc.
Mouth Breathing While Sleeping
Breathing through the mouth while sleeping is characterized by snoring and sleep apnea. Both of these are respiratory conditions, besides being individual medical conditions themselves, and may hint towards many other underlying health disorders such as obesity, heart diseases, sleep disorders, etc.
Diagnosis of mouth breathing
History: A good history should be recorded from the patient as well as parents.
Clinical examination: Look out for its various clinical features. A number of simple tests can be carried out to diagnose mouth breathing such as the mirror test, water test etc.
Cephalometrices: Cephalometric examination helps in establishing the amount of nasopharyngeal space, size of adenoids and also helps in diagnosing the long face associated with mouth breathing.
Rhinomanometry: It is the study of nasal air flow characteristics using devices consisting of flow meters and pressure gauges. These devices help in estimation of air flow through the nasal passage and resistance.
Management of mouth breathing
Removal of nasal or pharyngeal obstruction: Any nasal or pharyngeal obstruction should be removed by referring the patient to be E.N.T. surgeon.
Interception of the habit: Mouth breathing can be intercepted by use of a vestibular screen.
Alternatively adhesive tapes can be used to establish lip seal.
Rapid maxillary expansion: Patients with narrow, constricted maxillary arches benefit from rapid palatal expansion procedures aimed at widening the arch. Rapid maxillary expansion has been found to increase the nasal air flow and decrease the nasal air resistance.
Other treatment of myofunctional appliance.
Tongue thrust (also called reverse swallow or immature swallow) is the common name of orofacial muscular imbalance a human behavioral pattern in which the tongue protrudes through the anterior incisiors during swallowing, speech and white the tongue is at rest.
Genetic factors- Hypertonic orbicularis oris.
Behavior (habit) –Tongue thrust can be acquired as a habit.
The following predisposing factors that can lead to tongue thrusting.
- Improper bottle feeding
- Prolonged thumb sucking
- Prolonged tonsillar and upper respiratory tract infection
- Prolonged duration of tenderness of gum or teeth can result in a change in swallowing pattern to avoid pressure on the tender zone.
Maturation –Tongue thrust can present as part of a normal childhood behavior that is gradually modified as age advances.
The infantile swallow changes to mature swallow once the posterior decidious teeth start erupting. Sometimes the maturation is delayed and thus infective swallow persists for a longer duration of time.
Mechanical Restrictions- The presence of certain condition known as macroglossia, constricted dental arches and enlarged adenoid predispose to tongue thrust habit.
Neurological disturbance-Neurological disturbances affecting the oro-facial region such as hyposensitive palate and moderate motor disability can cause tongue thrust habit.
Psychogenic factors- Tongue thrust can sometimes occure as result of forced discontinuation of other habits like thumb sucking.
IMAGES:
CLASSIFICAION OF TONGUE THRUST
James Braner & Holt have classified tongue thrust as follows:
Type 1: - Non deforming tongue thrust
Type 2: -Deforming anterior tongue thrust
Subgroup 1: Anterior open bite
Subgroup 2: Anterior proclination
Subgroup 3: Posterior cross bite
Type 3: -Deforming lateral tongue thrust
Sub group 1 –Posterior open bite
Sub group 2 –Posterior cross bite
Sub group 3 –Deep over bite
Type 4: -Deforming anterior and lateral tongue thrust
Sub group 1 –anterior and posterior open bite
Sub group 2 –Proclination of anterior teeth
Sub group 3 –Posterior cross bite
Effects of tongue thrusting
- Proclination of anterior teeth
- Anterior open bite
- Bimaxillary protrusion
- Posterior open bite in case of lateral tongue thrust
- Posterior cross bite
- The “s” sound (lisping) is the one most affected because air forced on the side of tongue rather than forward.
TREATMENT
A)Habit Interception
1) The tongue thrust can be intercepted by use of habit breakers as describe for thumb sucking.
Both fixed and removable cribs or rakes are valuable aids in breaking the habit.
2) The child is taught the correct method of swallowing.
3) Various muscle exercise of the tongue can help in training it to adapt to the new swallowing pattern.
B)Treatment of malocclusion: Once the habit is intercepted the malocclusion associated with tongue thrust is treated using removable or fixed orthodontic appliances.
It usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for prolong duration. The presence of the habit is considered normal till the age of 3-4 years. Persistence of the habit beyond this age can lead to various malocclusions.
Causes:-
Freudian theory:
This theory was proposed by sigmond freud in the early part of this century. He suggested that a child passes through various distinct phases of psychological development of which the oral and the anal phases are seen in the first three year of life. In the oral phase, the mouth is believed to be an oro-erotic zone. The child has the tendency to place his fingers or any other object into the oral cavity. Prevention of such an act is believed to result in emotional insecurity and poses the risk of the child diversifying into other habits.
Oral drive theory of sears and Wise:
Sears and Wise in 1950 proposed that prolonged sucking can lead to thumb sucking.
Benjamin’s theory:
Benjamin has suggested that thumb sucking arises from the rooting or placing reflex seen in all mammalian infants. Rooting reflex is the movement of the infant’s head and tongue towards an object touching his cheek. The object is usually the mother’s breast but may also be a finger or a pacifier. This rooting reflex disappears in normal infants around 7-8 months of age.
Psychological aspects:
Children deprived of parental love; care and affection are believed to resort to this due to a feeling of insecurity.
Learned pattern: According to some authors, thumb sucking is merely a learned pattern with no underlying cause or psychological bearing.
Effects of thumb sucking:
- Labial tipping of maxillary anterior teeth resulting in proclination of maxillary anterior.
- The overjet increases due to proclination of the maxillary anterior.
- some children rest their hand on the mandibular anterior during the sucking acts. In such children lingual tipping of the mandibular incisor can be expected which further increases the overjet.
- Anterior open bite can occur as a result of restriction of incisor eruption and supraeruption of the buccal teeth.
- The cheek muscles contract during thumb sucking resulting a narrow maxillary arch which predisposes to posterior cross bites.
- The child may develop tongue thrust habit as a result of the open bite.
- The upper lip is generally hypotonic while the lower part of the face exhibits hyperactive mentalis activity.
IMAGES:
TREATMENT :
1)Psychological approach
-It is usually said that children laking parental care, love and affection resort to this habit, thus parents should be counseled to provide the child with adequate love and affection.
-The parents should also be advised to divert the child’s attention to other things such as play and toys.
-parents and dentist should seek to motivate the child.
IMAGES:
Dunlop’s Beta hypothesis:
-Dunlop put forward a theory called beta hypothesis that states that the best way to break a habit is by its conscious, purposeful repetition.
-Dunlop suggests that the child should be asked to sit in front of a mirror and asked to suck his thumb, observing him as he indulges in the habit.
-This procedure is very effective if the child is asked to do the same at a time when he is involved in all enjoyable activity.
Mechanical aids:-
They are basically reminding appliances that assist the child who is willing to quit the habit but it is not able to do so as the habit has entered a subconscious level. These appliances usually consist of a crib placed palatal to maxillary incisiors. Habit breakers can be of two types.
A)Removable habit breakers
They are passive removable appliances that consist of crib and anchored to the oral cavity by means of clasps on the posterior teeth.
Removable appliances used may be palatal crib, rakes, palatal arch, lingual spurs.
B)Fixed habit breakers
-Heavy gauge stainless steel wire can be designed to form a frame that is soldered to bands on the molars.
-Other aids that can be used to intercept that habit include bandaging the thumb.
-Fixed appliance such as upper lingual tongue screens apper to be made effective in breathing these habits.
-If child has made appreciable changes in his habit by 3 months the appliances can be safely removed for a testing period.
Chemical approach:
-Use of bitter tasting or foul smelling preparation placed on the thumb that is sucked can make the habit distasteful. The medicaments that can be used include
a)Pepper dissolved in a volatile medium
b)Quinine
c)Asafetida
Pulpectomy the complete removal of a pulp from the pulp chamber and root canal. The pulpectomy procedure is also called partial root canal. Pulpectomy refers to a common endodontic procedure in which the dental pulp and root canal are completely removed. This procedure is done on primary teeth.
- Inflammation extending beyond coronal pulp
- Primary teeth with necrotic pulps
- Roots and surrounding bone free of pathology
- At least ½ of root length remaining
- Second primary molar retention for the erupting first permanent molars
- No permanent successor
- Internal resorption without any obvious perforation
- Pulpless primary teeth with sinus tracts
CONTRAINDICATION
- Teeth with non restorable crowns
- Periradicular involvement extending to the permanent tooth bud
- Pathological resorption of at least one third of root with a fistulous sinus tract
- Excessive internal resorption
- Extensive pulp floor opening into the bifurcation
- Systemic disease such as congenital or rheumatic heart disease, hepatitis, leukemia.
- Primary teeth with underlying dentigerous or follicular cysts
IMAGE
PULPECTOMY TECHNIQUE
- Remove caries and determine site of pulp exposure
- Remove roof of the pulp chamber
- Remove coronal pulp tissue and identify root canals
- Clean out canals and remove pulp tissue
- Dry canals with paper points
- Fill root/coronal chamber with ZNOE
- Fill pulp chamber with thickened mix of paste
- Restore tooth with stainless steel crown
Pulpotomy as the complete removal of the coronal portion of the dental pulp followed by a placement of a suitable dressing or medicament that will promote healing and preserve vitality of the tooth.
The pulpotomy procedure involves removing the coronal pulp tissue that has undergone inflammation or degenerative changes and leaving intact the remaining vital tissue in the rootcanals which is then covered with pulpotomy agent to promote healing at the amputation site or an agent for fixation of the underlying tissue.
INDICATION FOR PULPOTOMY
- Carious primary teeth with infected pulp
- Irreversible inflamed pulp
- Failed in direct pulp capping
- Absence of spontaneous pain
- Absence of swelling or alveolar abscess formation
- 2/3 root length remaining
CONTRAINDICATION
- Permanent successor close to eruption
- An unrestorable tooth
- Less than 2/3 of root remaining
- Presence of fistula or swelling
- Evidence of necrotic irreversibly damaged pulp
- Uncontrolled pulpal hemorrhage
- Periapical or bifurcation or trifurcation radioluency
- Pathological resorption of pulp
- Dystrophic calcification(pulp stones)
IMAGES:
Medicaments available for pulpotomy
- Formocresol
- Mineral trioxide aggregate
- Glutaraldehyde solution
- Paraformaldehyde
- Calcium hydroxide powder
- Ferric sulphate
- Beechwood creosote
- Camphorated monochlorophenol
- Laser
- Electro surgery
- Creating
- ZOE
Pulpotomy technique
- Remove caries and determine site of pulp exposure
- Remove roof of the pulp chamber
- Remove coronal pulp tissue and control bleeding
- Appropriately use pulpal medicament
- Fill pulp chamber with cement/restore
Pit and fissure sealants are marketed in variety of formats; they can be filled, unfilled, tinted, clear or opaque. They may be polymerized in variety of ways.
The first generation of fissure sealants is ultraviolet light cure, the second generation is chemically cured (autopolymerised) and third generation is visible light cure. The fourth generation fissure sealants are those containing fluorides.
TYPE OF FISSURE SEALANTS
A)
1. Three different kinds of plastics have been used as occlusal sealants:
a) Polyurethanes
b) Cyanoacrylates
c) Bisphenol a glycidyl methacrylate (BIS-GMA)
2. Resin based sealants
3. Glass ionomer sealants
4. Fluoride containing sealants
B)
1. Filled and unfilled
2. Light cured and chemically (self) cured
3. Clear and tinted.
INDICATION
- Presence of deep occlusal pit and fissures of newly erupted teeth (molars and premolars).
- Presence of lingual pits or palatal pits in relation to upper lateral incisors and molars.
- Presence of incipient lesion in the pit and fissure system.
- Children and young people with medical, physical or intellectual impairment with high caries risk.
- Children and young people with signs of higher caries activity and coming from non fluoride area.
CONTRAINDICATION
- Presence of shallow pit and fissure of molars and premolars.
- An open occlusal caries lesion with exetension into dentin.
- Presence of large occlusal restoration.
- Presence of proximal caries extending on to occlusal surface.
- Partially erupted tooth where in isolation is a problem.
- Unco-operative children
 |
| Before |
 |
| During |
 |
| After |
TECHNIQUE FOR SEALANT APPLICATION
STEP 1: Prepare the teeth
-Clean the pit and fissure surfaces
-Utilize a dry toothbrush, properly cup with pumice or properly paste or air abrasion
-Use an explorer to remove any debris in the pit of fissure
-Rinse for 20-30 seconds
-Reevaluate surface for residual or loose debris
STEP 2: Isolate the teeth
-Use cotton rolls, dry angles and rubber dam.
STEP 3: Dry the surfaces
-Dry teeth with air for 20-30 seconds
-Check to make sure there is no moisture coming out of air syringe tip
STEP 4: Etch the surface
-Apply etchant as directed by manufacturer
-Usually between 30-60 seconds
-If using gel or semi-gel apply gel and let stand for allotted amount of time
-If using a liquid continue to apply etchant throughout the etchant time
STEP 5: Rinsing and drying the teeth
-Rinse surfaces for 60 seconds
-Check for effectiveness of etchant by drying with air, surface should appear “chalky white “
-If not, repeat etching procedure
-Placement of new cotton rolls and dry angles
-Dry teeth with air for 20-30 seconds
STEP 6: Application of sealant material
-Self curing: Mix equal parts of the two components
-Will polymerize in 60-90 seconds
-Light curing: Apply with syringe provided by manufacturer
-Apply curing light to material
-Will polymerize in 20-30 seconds
-Evaluate sealants for any voids, marginal discrepancies, or retention problems
-If noted return to step 2
STEP 7: Occlusal evaluation
-Check occlusion with articulating paper
-Adjustments must be made with filled resins
STEP 8: Setting re-evaluation sequence educating patient of the importance in having the sealants evaluated on six month basis
Baby bottle tooth decay also known as early childhood caries is a syndrome characterized by severe decay in the teeth of infants or young children. Baby bottle tooth caries is very common bacterial infection.
Causes and risk factors of baby bottle tooth decay:
This condition occurs when the baby’s teeth are exposed frequently and over a long period of time to the sugars presents in liquids such as milk formula and fruit juice. Bacteria in the mouth use these sugars as food.
They can produce acid attack for 20 minutes or longer. After many attacks the teeth can decay. This condition is known as baby bottle tooth decay or early childhood caries (cavities).
Mostly group of bacteria called streptococcus mutans and lactobacillus species are responsible for caries.
Symptoms:
- Upper front teeth appear teeth decay
- The decay looks like small dark holes or dark pits.
- Even broken teeth
- Pain and fever may also appear
- Difficulty in speaking or chewing
IMAGES:
.jpg)
TREATMENT:
1.FILLING:fill teeth by removing caries with dental hand piece and replacing it with material such as silver amalgam, composite resin, glass ionomer.
2.CROWN:“crown” or “caps” are used if teeth caries is extensive and there is limited tooth structure, which may cause weak teeth.
-large filling increase risk of tooth structure
-caries is removed and repaired and a crown is fitted over the remaining portion of tooth.
3.ROOT CANAL: When the nerve in tooth dies from caries or injury.
Pulp portion of tooth is removed along with caries of tooth. Roots are filled with sealing material. The tooth is filled and crown may be placed over tooth.
4.TOOTH EXTRACTION:when tooth is severe destroyed from dental caries and unable to restore teeth.
PREVENTION:
The good news is that tooth decay is almost completely preventable. You can help prevent tooth decay for your child by following the tips below:
-ORAL HYGIENE:
• Lower the risk of the baby’s infection with decay-causing bacteria. This can be done two ways – by improving the oral health of the mother/caregiver which reduces the number of bacteria in her mouth and by not sharing saliva with the baby through common use of feeding spoons or licking pacifiers and giving them to babies.
• After each feeding, wipe the baby’s gums with a clean, damp gauze pad or washcloth. This will remove plaque and bits of food that can harm erupting teeth. When your child’s teeth begin to erupt, brush them gently with a child’s size toothbrush and water. (Consult with your child’s dentist if you are considering using fluoride toothpaste before age two.)
• When your child can be counted on to spit and not swallow toothpaste (usually not before age two), begin brushing the teeth with a pea-sized amount of toothpaste.
• Brush your child’s teeth until he or she is at least six years old.
• Place only formula, milk or breast milk in bottles. Avoid filling the bottle with liquids such as sugar water, juice or soft drinks.
• Infants should finish their bedtime and naptime bottles before going to bed.
• If your child uses a pacifier, provide one that is clean — don’t dip it in sugar or honey, or put it in your mouth before giving it to the child. Encourage healthy eating habits that include a diet with plenty of vegetables, fruit and whole grains. Serve nutritious snacks and limit sweets to mealtimes.
• Ensure that your child has adequate exposure to fluoride. Discuss your child’s fluoride needs with your dentist.
- Diet for dental health
- Topical fluoride application
- Space maintainers
- Crowns
07 August 2012
Gold alloys contain gold, copper and other metals that results in a strong effective filling, crown or bridge.
Gold alloys are primarily used for inlays, onlays, crowns and fixed bridges.
There are two form of gold fillings, cast gold fillings(gold inlay and onlay) made with 14 or 18 kt gold and gold foil made with pure 24 kt gold.
IMAGES
1.GOLD INLAY
Gold inlay is basically gold filling which fits within the contours of tooth. The gold inlay involves the occlusal and proximal surface of posterior tooth and may cap one or more but not all of the cusps.
Gold inlay is custom crafted in dental laboratory to precisely fit tooth so it takes two appointments to restore tooth with an inlay.
INDICATION:
1. Replace over amalgam restoration.
2. When proximal surface caries is extensive.
3. Gold inlay restorations for class-1, class-4, class-5, and class-6 cavity.
2. GOLD ONLAY
Gold onlay involves the proximal surface of a posterior tooth and caps all of the cusps.
A gold onlay covers and protects the biting surface of a tooth that is severely damaged and not possible with dental filling.
INDICATION:
1. In posterior teeth after root canal treatment.
2. As a splinting to improve stability of the teeth.
3. Partial coverage of posterior teeth where significant loss of coronal dentine.
ADVANTAGE:
1. Strength (can withstand occlusal forces)
2. Long lasting life (at least 10 to 15 years)
3. Naturally beautiful
4. Gold is pliable.
5. Gold is versatile.
DISADVANTAGES:
1. Expensive
2. Galvanic shock
3. More visit
07 August 2012 0
Glass ionomer cement (GIC) is a dental restorative material used in dentistry for filling teeth and luting cements. These materials are based on silicate glass powder and polyalkenoic acid.
TYPES:
Glass ionomer are classified into five types.
1. Conventional glass ionomer cements.
2. Resin modified glass ionomer cements.
3. Hybrid ionomer cements. (Also known as dual cured glass ionomer cement).
4. Tri-cure glass ionomer cements.
5. Metal reinforced glass ionomer cements.
INDICATION:
1. Type-2 glass ionomer for restorations.
2. Type-3 glass ionomer for liners and bases.
3. Type-4 glass ionomer for fissure sealants.
4. Type-5 glass ionomer for core build up.
5. Intermediate Restorations.
6. Restorations for decidious teeth.
7. Adhesive cavity liners(sandwich technique)
IMAGES:
 |
| Before |
 |
| After |
ADVANTAGE:
- Inherent adhesion to tooth structure
- High retention rate
- Little shrinkage and good marginal seal
- Fluoride release and caries inhibition
- Biocompatible
- Minimal cavity preparation
DISADVANTAGE:
- Brittle
- Soluble
- Abrasive
- Water sensitive during setting phase
- Less aesthetic than composite
CONTRAINDICATION:
- Aesthetic requirement
- Area of high abrasion
- Area of high occlusal load
Dental composite resins are types of synthetic resins which are used in dentistry as restorative material or adhesives.
Composite resins are most commonly composed of BISGMA (Bisphenol Glycidyl Methacrylate).
Now UDMA (urethane dimethacrylate) and TEGDMA (Triethylene glycol dimethacrylate) are also being used.
Fillers used are quartz, silica, tricalcium phosphate, zirconium dioxide. They provide strength, hardness, rigidity to the material.
Coupling agent binds the resin matrix to the filler particles. Organic salines are commonly used coupling agents.
Coloring agents used are aluminium oxide, titanium dioxide.
Composite are divided into types depending upon the size, amount and composition of the inorganic filler.
TYPES:
- Conventional
- Microfilled
- Nanofilled
- Flowable composite
- Laser curing composite
- Packable composite
- Antibacterial composite
Placement of composite requires an etchant and bonding agent.
-On the bases of how they can be used the composite fillings are divided into two types
Direct dental composite
Direct dental composite placed by dentist in clinical one visit.
Composites are available in many shades so according to color of tooth shade is selected to give best esthetic results through single shade, dual shade and multilayering technique.
Before putting the resin in the cavity the area treated with an agent that is called as the etching process.
After etching and bond is applied which is cured by light then composite is placed and is cured with light.
Direct dental composites can be used for
- Filling gaps (diastemas) between teeth using a shell-like veneer.
- Minor reshaping of teeth.
- Partial crowns on single teeth.
INDIRECT DENTAL COMPOSITE
This type of composite is cured outside the mouth.
Indirect composites can have higher filler levels and are cured for longer times
As result they have higher levels and depths of cure then direct composite.
Indirect dental composites can be used for
- Filling cavities in teeth as fillings, inlays and onlays.
- Filling gaps between teeth using a shell-like veneer.
- Reshaping of teeth.
- Full or partial crowns on single teeth.
- Bridges.
IMAGES
.jpg) |
| Before |
 |
| After |
Dental amalgam is the most commonly used dental restorative material used for dental fillings.
Fillings made with amalgam are also known as silver fillings.
Amalgam consists of combination of metals, these include silver, mercury, tin, copper and small amounts of zinc, iridium or palladium with development of tooth colored materials to restore teeth, amalgam is used less often than in the past.
INDICATION:
Amalgum restorations for class-1 cavity, class-2 cavity, class-3 cavity, class-4 cavity and class-5 cavity.
IMAGE:
ADVANTAGE:
- Long lasting and strong, with stand the forces of chewing.
- Less costly than the other material
DISADVANTAGE:
- amalgam doesn’t match with natural color of tooth.
- amalgam doesn’t bond with natural tooth.
- Requirement of cavity preparation to keep filling in place.
DEFINITION:“The periodontal pocket defined as a pathological deepened gingival sulcus.” There is also a loss of bone and disorganization of periodontal ligament.
Pocketing is the end result of inflammation and infection that causes the loss of tissue attachment to the teeth, one common consequence of periodontal disease.
IMAGES
GINGIVAL POCKET (False or Relative)
This is formed by gingival enlargement without destruction of the underlying periodontal tissue. The sulcus is deepened because of increased bulk of gingival.
PERIODONTAL POCKET (True)
This occurs with destruction of the supporting periodontal tissues. Progressive pocket depending leads to destruction of the supporting periodontal tissues and loosening and exfoliation of the teeth.
There are two types of periodontal pockets:
SUPRABONY (supracrestal or supraalveolar) in which the bottom of the pocket is coronal to underlying alveolar bone.
INFRABONY (intrabony, subcrestal or intraalveolar) in which the bottom of the pocket is apical to the level of the adjacent alveolar bone. Lateral pocket wall lies between the tooth surface and alveolar bone.
Pockets can involve one, two, or more tooth surfaces and can be different depths and types on different surfaces of the same tooth and on approximating surface of the same interdental space.
SIGNS AND SYMPTOMS
- bluish red
- thickened marginal gingival
- bluish red vertical zone from the gingival margin to alveolar mucosa.
- gingival bleeding and suppuration
- tooth mobility
- distema formation
Symptoms such as
-localized pain or pain deep in the bone
-pocket depths and extent is determine by careful probing of the gingival margin along each tooth surface.
Pathogenesis:
Periodontal pockets are caused by microorganisms and their products which produce pathologic tissue changes that lead to deepening of the gingival sulcus.
Bacterial invasion:
Bacterial invasion of the apical and lateral areas of the pocket wall.
Filaments,rods,coccoid organisms with predominant gram-negative cell walls have been found in interalveolar spaces of the epithelium.
Bacteria invade the intercellular space under exfoliating epithelial cells but they are also found between deeper epithelial cells and accumulating on the basement lamina and invade the sub epithelial connective tissue.
POCKET CONTENTS:
Periodontal pockets contain debris consisting periapically of microorganisms and their products (enzymes, endotoxins and other metabolic products)
Gingival fluid, food remnants, salivary mucin, desquamated epithelial cells and leukocytes plaque covered calculus usually projects from the tooth surface.
Purulent exudates if present consists of living, degenerated and necrotic leukocytes, living and dead bacteria, serum and scant amount of fibrin.
Extensive pus formation may occur in shallow pockets
Deep pockets may exhibit little or no pus.
Repair, resection, regeneration and extraction.
TREATMENT:
1.Maintain good oral hygiene
2.Scaling & Root planning
3.Laser deep pocket cleaning
4.Gingival curettage
5.Gingivectomy
6.periodontal flap surgery
a) Papilla preservation flap
b) Sulcular incision flap
c) Modified widman flap
d) Undisplaced flap
e) Apically displaced flap with bone contouring
7.Resective osseous surgery
8.Reconstructive osseous surgery
9.tooth extraction or partial tooth extraction
(hemisection or root resection)
Abscesses of the periodontium are localized acute bacterial infections classified primarily based on location.
Types
There are four types of abscesses associated with the periodontal tissues:-
1. Gingival abscesses
2. Periodontal abscesses
3. Pericoronal abscesses
4. Combined periodontal/endodontic abscesses
IMAGES
LATERAL PERIODONTAL ABSCESS
Definition: “A periodontal abscess is a localized, purulent infection involves a greater dimension of gum tissues extending apically and adjacent to periodontal pocket such lesion may contribute to destruction of the periodontal ligament and alveolar bone.
Periodontal abscesses can be acute or chronic
Causes of lateral periodontal abscesses
- Continued irritation by calculus, food debris, deposition of foreign body in the interdental spaces
- lateral periodontal abscess is commonly associated to supra and infra bony pockets as they are very hard to clean.
- External root resorption
- cracked tooth
- perforation of lateral wall of tooth during root canal therapy possible cause.
SIGNS AND SYMPTOMS:
- mild, moderate to severe pain
- Gums are reddened, swollen and pus may come out an application of pressure
- tooth may show mobility, tenderness and slight elevation
- fever
- lymph node tenderness is common
- mouth opening may be difficult
TREATMENT:
- Incision and drainage
- Analgesic for eliminate pain
- Antibiotics for eliminate infection
- maintain oral hygiene
- scaling, gingivectomy if necessary
- examination if needed
Definition: periodontitis is the most common type of periodontal disease and results from extention of the inflammatory process initiated in the gingival to supporting periodontal tissues.
IMAGES
Etiology of periodontitis
- dental plaque
- Material Alba
- Dental calculus
- Microorganisms
- food debris
- poor oral hygiene
- dental stains
- Iatrogenic factors
- Faulty fixed or Removable prosthesis
- Food impaction
- Unreplaced missing teeth
- Malocclusion
- Mouth breathing
- Tobacco chewing
- Thumb sucking
- Cigarette smoking
- Toothbrush trauma
- chemical irritation
- bruxism
RISK FACTOR
- vit-c
- gingivitis
- Heredity
- poor oral health habits
- Tobacco use
- Diabetes
- older age
- Decreased immunity such as that occurring with leukemia or HIV-AIDS
- Poor nutrition
- certain medication
- Hormonal changes such as related to pregnancy
- ill fitting dental restorations.
PERIODONTITIS
Classified according to rate of progression
1) slowly progressive periodontitis
2)Rapidly progressive periodontitis
-Classified according to age at onset
1)Adult onset periodontitis
2)early onset periodontitis
a) Prepubertal periodontitis.
b) Juvenile periodontitis.
OTHER FORMS OF PERIODONTITIS
1) Aggressive periodontitis
2) Necrotizing ulcerative periodontitis
3) Refractory periodontitis
4) Periodontitis as manifestation of systemic disease
A) Associated with hematological disorders
1. Acquired neutropenia
2. Leukaemias
3. Others
B) Associated with genetic disorders
1. Familial and cyclic neutropenia
2. Down-syndrome
3. Leukocyte adhesion deficiency syndromes.
4.papillon lefevres syndrome
5. chediak-Higashisyndrome
6. Histocytosis syndrome
7. Glycogen storage disease
8. Infantile genetic agranulocytosis
9. Cohen syndrome
10.Ehlers-Danlos syndrome(type 4 and type 8)
11.Hypophosphatasia
12.Other
5)Combined periodontic endodontic lesion
6)Abscess of periodontitis
a)Gingival abscess.
b)Periodontal abscess.
c)peri coronal abscess.
SYMPTOMS OF PERIODONTITIS
- Red swollen or tender gums
- Bleeding gums during tooth brushing
- Halitosis or bad breath
- Gums that have palled always from teeth or gingival recession
- pus formation between teeth and gums
- Loosening or separating teeth
- Deep pockets between teeth and gums.
Periodontitis has been linked to increased inflammation in body such as indicated by raised levels of c-reactive protein and interleukin 6. It is through this linked to increased risk of stroke, myocardial infarction and atherosclerosis.
Diagnosis of periodontitis.
- Oral examination by dentist or dental hygienist.
- By x-rays
- Periodontal probing procedure
- Examination of periodontal pocket
Radiographic changes in periodontitis
Normally interdental septa
- The interdental septum normally presents a thin radio opaque border adjacent to and at the crest of periodontal ligament this border is referred to as laminadura
- Radiographically continuous white line but really it is perforated by numerous small foramina and traversed by blood vessels, lymphatic’s and nerve pass between periodontal ligament and bone.
- changes in angulations of x-rays beam produce considerable variations in its appearance.
AFTER PERIODONTITIS RADIOGRAPHIC CHANGES
- Fuzziness and break in the continuity of laminadura at the mesial and distal aspect of crest of interdental septum.
- Wedge shaped radiolucent area is formed at the mesial or distal aspect of crest of septal bone.
- Finger like radiolucent projections extend from crest into the septum & height is reduced.
- Height of interdental septum is progressively reduced by extention of inflammation and resorption of bone.
- Radioopaque horizontal line across the roots.
# TREATMENT PLAN OF PERIODONTITIS
There are several ways to treat periodontitis depending on its severity, etiology, symptoms and risk factors.
NONSURGICAL TREATMENTS
if periodontitis is not in advanced treatment can include less invasive procedure including
SCALING
Scaling removes plaque and food debris from tooth surfaces and beneath gums. It performed by ultrasonic scaler device.
ROOTPLANNING
Root planning smoothes the root surfaces and present further develop of plaque and calculus.
ANTIBIOTICS:
Topical or oral antibiotics to help control bacterial infection
NSAIDS : To reduce inflammation.
SURGICAL TREATMENTS:
If periodontitis may in advanced then surgical procedure may require such as
FLAP SURGERY
-In this procedure makes small incision in gums so that section of gum tissue is pull back exposing root surface for scaling and rootplaning.periodontitis may be causes bone loss, the underlying bone may be recontoured before the gum tissue
Is sutured back in place. The procedure is under local anesthesia.
SOFTT TISSUE GRAFTS:
If gum tissue lose in periodontal disease, and gumline recedes, making teeth appear longer than normal, then damaged tissue replaced by removing small
This procedure reduces gum recession, cover exposure of root surface, and give aesthetically pleasing appearance.
BONE GRAFTING:
This procedure is performed when periodontitis has destroyed bone surrounding tooth root surface. The graft may be small part of own bone or synthetic bone or donated. This bone graft helps prevent tooth bone loss by holding tooth in proper
Place. It also serve s base for regrowth of natural bone. Bone grafting may be performed during a technique called guided tissue regeneration.
GUIDED TISSUE REGENERATION
This allows the regrowth of bone that was destroying by bacterial infection. In this procedure a special biocompatible material places between existing bone and tooth. This stimulates growth of healthy bone and tissue.
PREVENTION:
- Flossing daily
- Brushing after meals every day.
- Balanced and healthy diet.
Subscribe to:
Posts (Atom)
